Longer term benefits of exercise and escitalopram in the treatment of anxiety in patients with coronary heart disease: Six month follow-up of the UNWIND randomized clinical trial.
Longer term benefits of exercise and escitalopram in the treatment of anxiety in patients with coronary heart disease: Six month follow-up of the UNWIND randomized clinical trial.
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DOI：
10.1016/j.ahj.2022.05.014
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发表时间：
2022-09
影响因子：
4.8
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中科院分区：
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焦虑是冠心病患者常见的合并症，与预后不良有关。然而，冠心病患者焦虑的有效治疗尚不确定。UNWIND随机临床试验显示，12周的艾司西酞普兰治疗在减轻焦虑的CHD患者的焦虑方面优于运动训练或安慰剂。治疗焦虑症的长期益处尚不清楚。患者随机接受12周的艾司西酞普兰（高达20 mg）、运动（3次/周）或安慰剂。在治疗结束时，对参与者进行6个月的随访，以确定通过医院焦虑和抑郁量表-焦虑量表（HADS-A）评估的主要焦虑终点的持续获益，并评估治疗对长达6年的随访期内主要不良心脏事件的影响。在最初随机分配的128名参与者中，120名（94%）可进行随访。随机分配至艾司西酞普兰条件的受试者表现出较低的HADS-A评分（3.9 [3.1，4.7]），与随机分配至运动组（5.5 [4.6，6.3]）（P = .007）和安慰剂组（5.3 [4.1，6.5]）（P = .053）相比。在中位随访3.2年（IQR：2.3，4.5）期间，有29起不良事件，但组间无显著差异。在UNWIND试验中，12周的艾司西酞普兰治疗可有效减轻焦虑。这些有益效果在治疗后持续了6个月。虽然适度或剧烈的身体活动对健康有许多好处，但运动并不是冠心病患者焦虑的有效治疗方法。
Anxiety is a common comorbidity in patients with coronary heart disease (CHD) and is associated with worse prognosis. However, effective treatment for anxiety in CHD patients is uncertain. The UNWIND randomized clinical trial showed that 12-week treatment of escitalopram was better than exercise training or placebo in reducing anxiety in anxious CHD patients. The longer-term benefits of treatment for anxiety are not known. Patients were randomized to 12 weeks of Escitalopram (up to 20 mg), Exercise (3 times/wk), or placebo pill. At the conclusion of treatment, participants were followed for 6-months to determine the persistence of benefit on the primary anxiety endpoint assessed by the Hospital Anxiety and Depression Scale-Anxiety scale (HADS-A) and to assess the effects of treatment on major adverse cardiac events over a follow-up period of up to 6 years. Of the 128 participants initially randomized, 120 (94%) were available for follow-up. Participants randomized to the Escitalopram condition exhibited lower HADS-A scores (3.9 [3.1, 4.7]) compared to those randomized to Exercise (5.5 [4.6, 6.3]) (P = .007) and Placebo (5.3 [4.1, 6.5]) (P = .053). Over a median follow-up of 3.2 years (IQR: 2.3, 4.5), there were 29 adverse events but no significant between-group differences. In the UNWIND trial, 12 weeks of escitalopram treatment was effective in reducing anxiety. These beneficial effects were sustained for 6 months posttreatment. Although moderate or vigorous physical activity has a number of health benefits, exercise was not an effective treatment for anxiety in patients with CHD.
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